Provider Demographics
NPI:1063097624
Name:CULP DENTAL PA
Entity type:Organization
Organization Name:CULP DENTAL PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CULP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-324-2921
Mailing Address - Street 1:1334 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2337
Mailing Address - Country:US
Mailing Address - Phone:803-324-2921
Mailing Address - Fax:
Practice Address - Street 1:1334 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2337
Practice Address - Country:US
Practice Address - Phone:803-324-2921
Practice Address - Fax:803-324-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-16
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty